Generation of Political Priority for Global Health Initiatives: A Framework and Case Study of Maternal Mortality

Abstract

Why do some global health initiatives receive priority from international and national political leaders while others receive minimal attention? We propose a framework for analyzing this question consisting of four categories of factors: the strength of the actors involved in the initiative, the power of the ideas they use to frame the issue, the nature of the political contexts in which they operate, and characteristics of the issue itself.We apply this framework to the case of a global initiative to reduce maternal mortality, launched in 1987. Using a process-tracing methodology commonly employed in qualitative research, we conducted archival research and interviewed actors involved in the initiative. We find that despite two decades of effort the initiative remains in an early phase of development, hampered by difficulties in all these categories. However, the initiative's twentieth anniversary year, 2007, presents opportunities to build political momentum. To generate political priority advocates will need to address several challenges, including the creation of effective institutions to guide the initiative and the development of a public positioning of the issue that convinces political leaders to act.We draw on the framework and case study to suggest areas for future research on the determinants of political priority for global health initiatives, a subject that has attracted much speculation but little scholarship.

Political priority of oral health in India: analysis of the reasons for neglect

“…The political power framework developed by Shiffman and Smith (2007) (13) and amended by Benzian et al (1) was used to determine the factors shaping political priority of oral health in India. The framework comprises four broad analysis areas, which are further divided into 11 analysis dimensions.…”

Generating political commitment for ending malnutrition in all its forms: A system dynamics approach for strengthening nutrition actor networks

“…To inform the development of the model on political commitment, we drew on several complementary theories applied in nutrition policy research. These included Shiffman and Smith's work on political priority for health; 32 Heaver 13 and te Lintelo's on political commitment for hunger and nutrition; 33 Pelletier et al on nutrition policy processes; 34,35 and Fox, Reich, and Balarajan's on the political economy of nutrition. 36,37 These are elaborated on extensively elsewhere.…”

“…It further involves designing and establishing effective institutions and policies that incentivize multisector responses at multiple levels, mobilizing resources and building capacities for policy implementation, and sustaining these actions over time in the face of opposition and changing conditions. 13,[32][33][34] It refers to both the intention to act (intentionality or willingness) and action itself. 13 Credible and sustained commitment-from political leaders who champion policy initiatives and government officials who coordinate action, to civil society groups who advocate for attention and resources, and ultimately affected community groups and individual citizens-is crucial to driving nutrition policy responses in the long term.…”

Making Markets for Merit Goods: The Political Economy of Antiretrovirals

“…Shiffman and Smith have examined in detail the tragic failure of campaigners to win enhanced international support to protect maternal mortality (Shiffman and Smith, 2007;Youde (2008) discusses the failure of the universal primary health care norm). Their ultimate conclusion was that campaigners lacked consensus on a policy prescription.…”